MISSISSIPPI LEGISLATURE REGULAR SESSION 2015

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1 MISSISSIPPI LEGISLATURE REGULAR SESSION 2015 By: Senator(s) Burton To: Public Health and Welfare SENATE BILL NO AN ACT TO AMEND SECTION , MISSISSIPPI CODE OF 1972, 2 TO DEFINE THE SCOPE OF PRACTICE AND TO REVISE AND MODERNIZE 3 REQUIREMENTS FOR CERTIFICATION AS A NURSE PRACTITIONER BY THE 4 MISSISSIPPI BOARD OF NURSING; TO ESTABLISH CRITERIA FOR THE 5 COLLABORATION OF THE SERVICES OF A CERTIFIED NURSE PRACTITIONER 6 WITH THE PRACTICE OF A LICENSED PHYSICIAN; TO AMEND SECTION , MISSISSIPPI CODE OF 1972, TO PROVIDE THAT COLLABORATIVE 8 AGREEMENTS BETWEEN NURSE PRACTITIONERS AND LICENSED PHYSICIANS 9 SHALL BE APPROVED BY THE STATE BOARD OF MEDICAL LICENSURE AND TO 10 AUTHORIZE A NURSE PRACTITIONER WHOSE COLLABORATIVE AGREEMENT HAS 11 BEEN DENIED OR TERMINATED TO APPEAL SUCH ACTION TO THE STATE BOARD 12 OF HEALTH; AND FOR RELATED PURPOSES. 13 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI: SECTION 1. Section , Mississippi Code of 1972, is amended as follows: (1) Advanced practice registered nurses; certified nurse practitioners. Any nurse desiring to be certified as an advanced practice registered nurse or certified nurse practitioner shall apply to the board and submit proof that he or she holds a current license to practice professional nursing and that he or she meets one or more of the following requirements: (a) Satisfactory completion of a formal post-basic educational program of at least one (1) academic year, the primary G1/2 PAGE 1 (tb\rc)

2 purpose of which is to prepare nurses for advanced or specialized practice. (b) Certification by a board-approved certifying body. Such certification shall be required for initial state certification and any recertification as a registered nurse anesthetist, nurse practitioner or nurse midwife. The board may by rule provide for provisional or temporary state certification of graduate nurse practitioners for a period of time determined to be appropriate for preparing and passing the National Certification Examination. Those with provisional or temporary certifications must practice under the direct supervision of a licensed physician or a certified nurse practitioner or certified nurse midwife with at least five (5) years of experience. (c) Graduation from a program leading to a master's or post-master's degree in a nursing clinical specialty area with preparation in specialized practitioner skills. (2) Rulemaking. The board shall provide by rule the appropriate requirements for advanced practice registered nurses in the categories of certified registered nurse anesthetist, certified nurse midwife, certified nurse practitioner and advance practice registered nurse. (3) Collaboration. An advanced practice registered nurse or certified nurse practitioner shall perform those functions authorized in this section within a collaborative/consultative relationship with a dentist or physician with an unrestricted PAGE 2 (tb\rc)

3 license to practice dentistry or medicine in this state and within an established protocol or practice guidelines, as appropriate, that is filed with the board upon license application, license renewal, after entering into a new collaborative/consultative relationship or making changes to the protocol or practice guidelines or practice site. The board shall review and approve the protocol to ensure compliance with applicable regulatory standards. The advanced practice registered nurse may not practice as an APRN and the certified nurse practitioner may not practice as a CNP if there is no collaborative/consultative relationship with a physician or dentist and a board-approved protocol or practice guidelines. (4) Renewal. The board shall renew a license for an advanced practice registered nurse or certified nurse practitioner upon receipt of the renewal application, fees and protocol or practice guidelines. The board shall adopt rules establishing procedures for license renewals. The board shall by rule prescribe continuing education requirements for advanced practice nurses and certified nurse practitioners not to exceed forty (40) hours biennially as a condition for renewal of a license or certificate. (5) Reinstatement. Advanced practice registered nurses and certified nurse practitioners may reinstate a lapsed privilege to practice upon submitting documentation of a current active license to practice professional nursing, a reinstatement application and PAGE 3 (tb\rc)

4 fee, a protocol or practice guidelines, documentation of current certification as an advanced practice nurse or certified nurse practitioner in a designated area of practice by a national certification organization recognized by the board and documentation of at least forty (40) hours of continuing education related to the advanced clinical practice of the nurse practitioner within the previous two-year period. The board shall adopt rules establishing the procedure for reinstatement. (6) Changes in status. The advanced practice registered nurse or certified nurse practitioner shall notify the board immediately regarding changes in the collaborative/consultative relationship with a licensed physician or dentist. If changes leave the advanced practice registered nurse or certified nurse practitioner without a board-approved collaborative/consultative relationship with a physician or dentist, the advanced practice nurse or certified nurse practitioner may not practice as an advanced practice registered nurse or certified nurse practitioner, as the case may be. (7) Practice requirements. The advanced practice registered nurse and the certified nurse practitioner shall practice: (a) According to standards and guidelines of the National Certification Organization. (b) In a collaborative/consultative relationship with a licensed physician or dentist whose practice is compatible with that of the nurse practitioner. Certified registered nurse PAGE 4 (tb\rc)

5 anesthetists may collaborate/consult with licensed dentists. The advanced practice nurse or certified nurse practitioner must be able to communicate reliably with a collaborating/consulting physician or dentist while practicing. (c) According to a board-approved protocol or practice guidelines. (d) Advanced practice registered nurses practicing as nurse anesthetists must practice according to board-approved practice guidelines that address pre-anesthesia preparation and evaluation; anesthesia induction, maintenance, and emergence; post-anesthesia care; peri-anesthetic and clinical support functions. (e) Advanced practice registered nurses practicing in other specialty areas must practice according to a board-approved protocol that has been mutually agreed upon by the nurse practitioner and a Mississippi licensed physician or dentist whose practice or prescriptive authority is not limited as a result of voluntary surrender or legal/regulatory order. (f) Each collaborative/consultative relationship shall include and implement a formal quality assurance/quality improvement program which shall be maintained on site and shall be available for inspection by representatives of the board. This quality assurance/quality improvement program must be sufficient to provide a valid evaluation of the practice and be a valid basis for change, if any. PAGE 5 (tb\rc)

6 (g) Nurse practitioners may not write prescriptions for, dispense or order the use of or administration of any schedule of controlled substances except as contained in this chapter. (h) The following conditions shall apply to the practice of nurse practitioners under a collaborative agreement with a licensed physician or dentist: (i) Under the general supervision of a licensed physician or dentist, a certified nurse practitioner may provide to patients of record all the services of a registered nurse and the diagnosis of illness and physical conditions and the performance of therapeutic and corrective measures within a specialty of practice. For purposes of this subparagraph (i), "general supervision" means supervision of a nurse practitioner requiring that the patient be a patient of record, that the physician or dentist examine the patient not more than nine (9) months prior to the date that the nurse practitioner provides the nurse practitioner services, and that the physician or dentist authorize the procedures which are being carried out by a notation in the patients record, but not requiring that a physician or dentist be present when the authorized procedures are being performed. The authorized procedures may also be performed at a location not more than one hundred (100) miles from the physician's or dentist's usual place of practice. PAGE 6 (tb\rc)

7 (ii) No physician or dentist shall enter into collaborative practice agreements with more than ten (10) certified nurse practitioners who are not located and practicing on the same physical premises as the collaborating physician or dentist. (iii) The certified nurse practitioner has current CPR certification and complies with the established protocols for emergencies which the supervising physician or dentist has established. (iv) The patient of record is notified in advance of the appointment that the supervising physician or dentist will be absent from the location where the nurse practitioner services are performed. (v) The licensed physician or dentist is responsible for all actions of the certified nurse practitioner during treatment of patients under general supervision. (8) Prescribing controlled substances and medications. Certified nurse midwives and certified nurse practitioners may apply for controlled substance prescriptive authority after completing a board-approved educational program. Certified nurse midwives and certified nurse practitioners who have completed the program and received prescription authority from the board may prescribe Schedules II-V. The words "administer," "controlled substances" and "ultimate user," shall have the same meaning as set forth in Section , unless the context otherwise PAGE 7 (tb\rc)

8 requires. The board shall promulgate rules governing prescribing of controlled substances, including distribution, record keeping, drug maintenance, labeling and distribution requirements and prescription guidelines for controlled substances and all medications. Prescribing any controlled substance in violation of the rules promulgated by the board shall constitute a violation of Section (1)(f), (k) and (l) and shall be grounds for disciplinary action. The prescribing, administering or distributing of any legend drug or other medication in violation of the rules promulgated by the board shall constitute a violation of Section (1)(f), (k) and (l) and shall be grounds for disciplinary action. SECTION 2. Section , Mississippi Code of 1972, is amended as follows: (1) Registered nurses who are licensed and certified by the Mississippi Board of Nursing as nurse practitioners * * * shall practice under the general supervision of a licensed physician pursuant to the requirements and conditions of Section under a collaborative relationship approved by the State Board of Medical Licensure. (2) In the event that a proposed written practice collaborative agreement for the practice of a certified nurse practitioner with a licensed physician is denied by the State Board of Medical Licensure, the certified nurse practitioner shall have the right to appeal the decision disapproving the PAGE 8 (tb\rc)

9 collaborative agreement to the State Board of Health within thirty (30) days of the decision of denial. In the event that said denial by the State Board of Medical Licensure is due to no fault on the part of the nurse practitioner and the nurse practitioner demonstrates that he or she has made a good-faith effort to enter into the collaborative written practice agreement with a collaborating physician and has been unable to do so, the State Board of Health shall be authorized to approve the collaborative agreement for the practice of said certified nurse practitioner. The review by the State Board of Health shall be de novo and the board may appoint a hearing officer to take testimony and prepare a record and recommendation to the State Board of Health. Any decision by the State Board of Health may be appealed to the Circuit Court of the First Judicial District of Hinds County in the same manner as other appeals of the decisions of state agencies. SECTION 3. This act shall take effect and be in force from and after July 1, ST: Nurse practitioners; define scope of PAGE 9 (tb\rc) practice and revise certification and collaboration requirements.

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